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Pulmonary Block > Pneumonia Bacterial Pathogens > Flashcards

Pneumonia Bacterial Pathogens Flashcards

1
Q

Strep pneumo risk factors

A

alcohol/drug intoxication causing cerebral impairment depressing the cough reflex and increasing aspiration; abnormality of the reps fact including injury, infection, and obstruction; abnormal circulatory dynamics; splenectomy, sickle cell, HIV

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2
Q

How is sickle cell a risk factor for strep pneumo

A

auto-splenectomy. Encapsulated pathogens like strep pneumo are typically cleared by the spleen

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3
Q

Strep pneumo virulence factors

A

capsule, lipoteichoic acid (activates complement, induces cytokine production), IgA protease enhancing ability to colonize mucosa

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4
Q

How is strep pneumo diagnosed

A

Urinary antigen, Gram stain and culture; it is optochin sensitive and shows Quellung reaction

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5
Q

What does strep pneumo look like on gram stain

A

Lancet-shaped, gram positive diplococcus

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6
Q

Treatment options for Strep pneumo

A

Ceftriaxone, Amoxicillin, Levofloxacin, Azithromycin

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7
Q

Strep pneumo vaccines

A

Pneumovax (23 type) provides 5yrs of protection used for people 65+ and those at heightened risk

Prevnar (13 types) recommended for children and infants

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8
Q

Herd Immunity

A

if most of the population receive a vaccine then those who do not are protected because they are surrounded by people who will not get the disease

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9
Q

What populations usually get mycoplasma pneumonia

A

military recruits, prison inmates, and school aged children

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10
Q

Mycoplasma pneumonia’s pathogenesis

A

Adhesin binds to ciliated epithelial cells and causes reduced ciliary clearance

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11
Q

Diagnostic methods for myoplasma infection

A

Cold agglutinins (IgM), serology, grown on Eaton agar, PCR on respiratory secretions

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12
Q

Best treatment for Mycoplasma

A

Levofloxacin, Azithromycin, or Doxycycline

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13
Q

Why does penicillin not work to treat mycoplasma

A

Mycoplasma has no cell wall

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14
Q

Chlamydia pneumonia

A

similar presentation to mycoplasma (walking pneumonia) except more common in older people (40ish); has no good diagnostic test; treat with Doxycycline

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15
Q

Psuedomonas typical habitat

A

common in hospital; lives in wet environments and can be problematic for patients on ventilators; also in soil and plants

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16
Q

Pseudomonas microbiologic features

A

non-fermentative, motile, oxidase-positive, elaboration of green pigment; smells fruity

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17
Q

H. influenza microbiologic features

A

small, pleomorphic; facultatively anaerobic, nonmotile

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18
Q

Klebsiella pneumonia microbiologic features

A

lactose fermenting, indole-negative; incapable of growth at 10C

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19
Q

A. baumanii microbiologic features

A

gram-negative coccobacilli, non-motile, strictly aerobic, catalase positive, oxidase-negative

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20
Q

Microplasma pneumonia virulence factor

A

Adhesin

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21
Q

Ps. aeruginosa virulence factor

A

endotoxin and exotoxin A (enzyme blocks protein synthesis by inactivating EF-2 by ADP ribosylation), elastase, leucocidin, lemolysins, alginate, exoenzyme S

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22
Q

Staph aureus virulence factor

A

enterotoxin

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23
Q

S. pneumonia virulence factor

A

capsule

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24
Q

Pseudomonas effects

A

can cause extensive vasculitis with thrombosis and hemorrhage with necrosis

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25
Q

Antibiotics for psuedomonas

A

Cefepime, Zosyn, Meropenem, Ciprofloxacin

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26
Q

Legionella location

A

contaminated water source (hotel/hospital showers, hot tubs, AC units)

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27
Q

Legionella signs and symptoms

A

fever, dry cough, diarrhea, confusion, Hyponatremia in older smoking population with comorbidities

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28
Q

Legionella Diagnostic tools

A

CXR, silver stain, culture on charcoal yeast extract agar enriched with cysteine and iron, urinary antigen testing, direct fluorescent antibody

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29
Q

Pontiac fever

A

acute, febrile self limited illness; symptoms include fever, malaise, chills, fatigue, HA, no respiratory complaints; no abnormalities on CXR; usually requires no treatment

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30
Q

Legionella Virulence factors

A

intracellular (results in decreased clearance and can parasitize and live in alveolar macrophages); cell wall endotoxin (major virulence factor; causes host inflammatory response which causes lung damage)

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31
Q

Treatment for Legionella

A

Levofloxacin and Azithromycin

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32
Q

Crackles

A

scratchy sounds caused by accumulation of fluid/white cells/bacteria in alveolar and interstitial spaces

33
Q

Bronchial breath sounds

A

dense consolidation of lung parenchyma results in transmission of large airway noises to the periphery

34
Q

Dullness to percussion

A

normal, air filled tissue has been displaced by fluid or infiltrated with white cells and bacteria

35
Q

Increased tactile fremitus

A

consolidation alters transmission of air and sound.

36
Q

Lung consolidation

A

occurs when lung parenchyma becomes engorged with fluid or tissue usually in the presence of pneumonia

37
Q

Organisms that cause community acquired pneumonia

A

staph aureus, Hemophilus influenza, klebsiella pneumonia, moraxella catarrhalis

38
Q

What bacteria causes currant jelly sputum, often seen in chronic alcoholics and malnourished

A

Klebsiella pneumonia

39
Q

What bacteria is seen in post-viral respiratory infections

A

Staph aureus

40
Q

Bacteria very common cause of hospital acquired PNA

A

Staph aureus

41
Q

Bacteria with 6 serotypes, encapsulated and non, gram - coccobacillary

A

H. influenza

42
Q

Bacteria grows on chocolate agar, requires factors V and X for growth

A

H. influenza

43
Q

Bacteria that have complications including abscess and necrotizing PNA

A

Staph aureus and Klebsiella pneumonia

44
Q

Bacteria with common drug resistance

A

S. aureus and K. pneumonia

45
Q

Bacteria where amoxicillin is used for mild infection and ceftriaxone is used for serious infections

A

H. influenza

46
Q

Bacteria where capsule is one of the major virulence factors

A

H influenza and K. pneumonia

47
Q

Bacteria that also causes otitis media, epiglottitis, and meningitis

A

H. influenza

48
Q

Bacteria whose vaccine incorporates the capsular polysaccharide b; and antibodies against capsule are protective

A

H. influenza

49
Q

Common bacterial cause of acute exacerbations

A

H influenza and M. catarrhalis

50
Q

Hospital acquired pneumonia risk factors

A

severe underlying disease, immunosuppression, prolonged antibiotic therapy, invasive devices such as IV catheters, mechanical ventilation

51
Q

Difference between hospital acquired and health care associated pneumonia

A

HAP acquired during hospital stay; HCAP is hospitalization of at least 2 days within 90days; received IV therapy, wound care, or chemo in 30days; resident of nursing home; has hemodialysis

52
Q

Most common organisms to cause HCAP

A

Pseudomonas aeruginosa and Staphylococcus aureus

53
Q

Alpha hemolysis

A

seen in strep pneumo; shows dark red outline on blood agar

54
Q

Beta hemolysis

A

seen in staph pyogenes; looks bright yellow on blood agar

55
Q

Quellung reaction

A

antibodies to capsule material causing swelling

56
Q

Optochin

A

used to distinguish S. pneumo (sensitive) from viridans strep

57
Q

Step pneumo invasion

A

can alter vascular permeability to allow access to blood stream and cause bacteremia; can also directly invade endothelial cells; can cross blood brain barrier by binding to cerebral capillaries and cause meningitis

58
Q

Strep pneumo virulence factors

A

capsule (resists phagocytosis), pili (used for bacterial adhesion to epithelial cells), cell wall components (techie acids and lipotechoic acid that cause inflammatory response)

59
Q

Mycoplasma facts

A

lack a cell wall, smallest free-living organism, can cause primary atypical pneumonia; pleomorphic with polar structure

60
Q

Mycoplasma virulence

A

attaches to surface of respiratory epithelia, and the lipoproteins interact with alveolar macrophage Toll-like receptors activating the production of inflammatory cytokines

61
Q

Chlamydia pneumonia pathogenesis

A

transmitted via respiratory droplets or secretions, gradual onset of cough leading to pneumonia, can range from asymptomatic to severe, most common in school age children

62
Q

Chlamydia pneumonia extrapulmonary associations

A

associated with chronic atherosclerotic disease

63
Q

Legionella

A

Typically effects elderly, immunocompromised, heavy smokes, alcoholics, and others with compromised lungs; generally spread by fomites and vehicles (water), can survive community water treatment, usually occurs in isolated incidence but associated with mass outbreaks

64
Q

Legionella virulence factors

A

replicates in alveolar macrophages after inhalation; it avoids phagosome-lysosome fusion by creating a specialized vacuole that resembles the ER of the host and supports bacterial replication (wild type and Dot/Icm - type IV secretion system)

65
Q

Staph aureus micro

A

colonize the nasal passages but can be found on the skin; form large yellow colonies on rich agar medium; catalase +, coagulase +, hemolytic

66
Q

Staph epi micro

A

colonizes the skin; forms small white colonies on rich agar medium; catalase +, coagulase -, non-hemolytic

67
Q

Primary infections caused by staph aureus

A

Pneumonia and Meningitis

68
Q

Primary infections by staph epi

A

usually nosocomial infections of implants

69
Q

Pathogenesis of staph aureus

A

many virulence factors including adhesins, invasins, antiphagocytic surface factors, immunologic decoys, lytic toxins, exotoxins, and abx resistance

70
Q

H. flu virulence

A

Capsule polysaccharide (serotype B)

71
Q

H flu vaccine

A

Hib - type b capsular polysaccharide conjugated to a carrier protein (diphtheria) - given to children 2-15 months

72
Q

Pseudomonas micro

A

important nosocomial pathogen especially in patients with leukemia, cystic fibrosis, and extensive burns; has ability to survive and proliferate in water

73
Q

Klebsiella micro

A

large capsule, no one antigen is associated with disease; causes lobar pneumonia; opportunistic infections

74
Q

Enterobacter micro

A

opportunistic pathogens, nosocomial infections in patients on anitbiotics

75
Q

Klebsiella staining

A

negatively stained with India ink revealing the cell wall

76
Q

Strep pyogenes facts

A

Group A Strep (GAS) beta hemolytic - strep throat; causative agent of numerous local and systemic disease and post-disease sequelae; can cause necrotizing fasciitis, shock, sequelae including acute rheumatic fever or glomerulonephritis

77
Q

Strep agalactiae facts

A

Group B strep (GBS) beta hemolytic

78
Q

Strep pyogenes pathogenesis

A

M proteins (resist phagocytosis), hyaluronic acid capsule, adhesins, invasins, exotoxins, strep pyrogenic exotocins

Pulmonary Block (8 decks)

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